Tuesday, December 06, 2011

Meaningful Abuse

As health care reform rumbles along, it has become increasingly clear that electronic health records (EHRs) are here to stay. I dare say, most of us are relatively happy that the change has come: notes are legible, information moves quickly, communication channels between doctor and patient are improved, and work flows streamlined.

Well, not always.

Take the example of the work flow required to process a simple office-based EKG:
  • Enter an order for an EKG
  • perform the EKG
  • A doctor edits, interprets and signs the computer-interpreted paper EKG
  • EKG and it's edits are loaded on the central EKG server
  • the results are electronically "signed" by the doctor on central EKG server to it can get posted as "final" on the EHR
  • A notice appears in the doctor's EHR results in-box notifying him that a new EKG result is available for review.
  • Ideally, the doctor attaches a "result note" explaining the results to the patient and the result forwarded to the patient electronically.
  • Except many patients don't use a computer
  • So the patient is called and another hand-typed electronic telephone note added to the patient's electronic health record to document that the patient was informed of the result.
All of this time, energy, effort, for a single EKG.

Now, multiple that by ten EKG's, three echos, two chest-xrays, and a partridge in a pear tree that gets ordered on our patients each day and you've just created "result bloat" for doctors.

When a single test result must be "resulted" three or more times by the attending physician because of constraints of conjoined information technologies, not only do we demonstrate meaningful use of our electronic medical records, but we also demonstrate meaningful abuse of our doctors' and support staffs' precious time.

First we saw "note bloat."

Now we're seeing "result bloat."

Washington, are you listening?



Pluripotent said...

The last question is the crux of the whole thing... "Washington, are you listening." The fact that you now need to beg Washington in order to make simple changes in workflow. Are you not a professional? Can you not make decisions for yourself? No. We have bureaucrats for that. Citizens shouldn't be allowed to think.

Anonymous said...

I need an "efficiency expert". I suspect a couple of those steps are done in a nano second by the computer. And I suggest that a time study comparison be done between the old "manual" way and the new digital way with an additional step which will give us a better understanding. Include a step when the patient comes back in 3 years suffering some discomfort and you need to do another EKG and compare those results to the one done 3 years ago. I bet there is a big time savings at that point.

Tim Hulsey, MD said...

Anonymous said, "...I suggest that a time study comparison..." You might want to update what you think doctors do. We see and treat patients. There is more demand on our time by patients than ever before. Eye-to-eye with patients is our playing field. That's the only time study for which I have time. You do a time study on how much time I waste searching a 4 page EMR generated referral note to find the one paragraph that is pertinent! Just one more thing to decrease the available eye-to-eye time. For you efficiency experts' information, the diagnosis is made most frequently by taking a history. That means listening to the patient and asking appropriate, probing questions to extract more information, while interpreting not only the patient's answers, but also interpreting the patient's reactions and facial expressions. At this point, that requires the computational prowess of the human (doctor's) mind AND time!
Efficiency expert! I'll leave that to the MPHs and MPPs and the rest of you who think practicing medicine is so cut and dried. Walk a mile in my shoes. You'll have a lot of miles to choose from in 37 years, and you might learn something along the way.

Anonymous said...

EPIC (the system used) are you listening.. This is not primarily a Washington problem. What would you think is the ideal way to do this? Come up with the best idea and it should be implementable... The banking and airline industries would not accept this program. The level of proprietary ownership of the program blocks improvement and innovation.